Olecranon fixation with two bicortical screws.

AIMS: The aim of this study is to report the results of a case series of olecranon fractures and olecranon osteotomies treated with two bicortical screws. METHODS: Data was collected retrospectively for all olecranon fractures and osteotomies fixed with two bicortical screws between January 2008 and December 2019 at our institution. The following outcome measures were assessed; re-operation, complications, radiological loss of reduction, and elbow range of flexion-extension. RESULTS: Bicortical screw fixation was used to treat 17 olecranon fractures and ten osteotomies. The mean age of patients being treated for olecranon fracture and osteotomy were 48.6 years and 52.7 years respectively. Overall, 18% of olecranon fractures were classified as Mayo type I, 71% type II, and 12% type III. No cases of fracture or osteotomy required operative re-intervention. There were two cases of loss of fracture reduction which occurred in female patients ≥ 75 years of age with osteoporotic bone. In both cases, active extension and a functional range of movement was maintained and so the loss of reduction was managed non-operatively. For the fracture fixation cohort, at final follow-up mean elbow extension and flexion were -5° ± 5° and 136° ± 7°, with a mean arc of motion of 131° ± 11°. CONCLUSION: This series has shown that patients regain near full range of elbow flexion-extension and complication rates are low following bicortical screw fixation of olecranon fractures and osteotomy.Cite this article: Bone Joint Open 2020;1-7:376-382.

Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation.

PURPOSE: Dynamic intraligamentary stabilization (DIS) is recognized as a ligament preserving technique for the treatment of acute anterior cruciate ligament (ACL) injuries. The aim of this study was to assess the integrity and morphology of the recovered ACL after DIS repair. METHODS: The cohort comprised 47 patients with an acute proximal ACL rupture undergoing DIS repair. All patients underwent diagnostic arthroscopy after a minimum postoperative interval of 6 months for semi-quantitative evaluation of ACL integrity, function and scar tissue formation. Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores as well as objective anteroposterior (ap) translation were assessed at 6 weeks, 3-, 6-  and 12 months postoperatively. RESULTS: Full restoration of the ACL volume was affirmed in 30 (63.8%) patients and two-third restoration in 13 (27.7%). Hypertrophic scar formation was observed in 23 (48.9%) patients. Forty-four patients (93.6%) demonstrated sufficient ACL tensioning intraoperatively upon anterior stress. At final follow-up, the median Tegner activity level was 5.5 (3-10), Lysholm and IKDC scores were 100 (64-100) and 94 (55-100) points, respectively. The mean ap-translation differed from the normal knee by 2.1 ± 2.2 mm. Deficient ACL recovery was noted in four patients (8.5%), none of which required secondary reconstructive surgery. CONCLUSION: The results demonstrate that clinical recovery of ACL function after DIS repair is resultant to both restoration of ACL volume and scar tissue formation. Factors influencing the degree of scar tissue formation need further investigation to enable future attempts of guiding a balanced biological healing response. LEVEL OF EVIDENCE: IV.

Isolated lower limb hypoplasia secondary to congenital varicella syndrome: a rare occurrence and management of its complications.

Isolated lower limb hypoplasia is a rare consequence of maternal congenital varicella syndrome (CVS). The hypoplastic limb is susceptible to multiple injuries, including fractures, especially if there is associated muscle weakness and lack of sensation. We describe a unique index case of a woman aged 26 years with a background of CVS who presented with a distal femur fracture following a fall onto her insensate, hypoplastic right leg. This report highlights the complexities involved in the diagnosis and management of fractures in patients with an anaesthetic limb, and in particular describes limb amputation as a successful treatment modality for distal femur fractures.

Fixation of olecranon fractures and osteotomies using compression screws: a simple solution to a common problem. A study of cases.

Olecranon fractures are common skeletal injuries accounting for approximately 10% of upper extremity fractures in adults. Simple non-comminuted fractures are traditionally fixed using the tension band wiring technique. This technique, however, has several complications, most commonly prominence of the metalwork frequently requiring surgery for removal. We describe a retrospective review of a new method of fixation for these fractures using partially threaded screws in an attempt to avoid these complications. We used two 3.5 and/or 4 mm partially threaded screws to fix seven simple olecranon fractures and two olecranon osteotomies. Notes and clinic letters of all nine patients were reviewed for demographic data, operation details and complications. Radiographs were reviewed at final clinical follow-up. The Mayo Elbow Performance Score was completed during a telephone consultation. One patient injured her elbow postoperatively, which resulted in fragmentation of the proximal segment and loss of fixation. In one patient the tip of the screws broke after a fall but this did not result in loss of fixation. There were no problems with metalwork prominence or skin irritation in any of the patients. Two patients had low scores due to loss of fixation, and severely comminuted supracondylar fracture of the humerus. Six patients had good scores. We believe that use of AO compression screws is a valid method for the fixation of simple fractures of the olecranon. It is a safe technique and has several advantages over tension band fixation. There is minimal tissue dissection and operating time is decreased. There is minimal risk of metalwork prominence as screws obtain good purchase in the anterior cortex of ulna. Good interfragmentary compression is achieved as screws are perpendicular to the fracture line and two screws provide good rotational stability. Protection of fixation for 1014 days does not result in significant loss of range of motion. Further clinical and biomechanical studies are suggested to compare this technique with other methods of fixation of olecranon fractures.

Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): technique description with prospective series of 20 tibial fractures.

Bridging-MILPO provides an alternative to other internal and external devices in the management of tibial fractures. A pre-contoured, stainless steel locking compression plate (Synthes) is fed subcutaneously through a small incision from a site distant to the zone of injury across the fracture site, respecting the fracture haematoma. Two or three locking screws are placed specifically at the ends of the plate. This 'spring leaf' like construct allows micro-motion at the fracture site. This induces callus formation, initially on the opposite cortex from the plate, accelerated by the allowance of immediate full weight bearing post-operatively. Twenty cases were performed over a 3-year period. Excellent final results were obtained in 19 out of the 20 cases. Complications included two superficial wound infections, one delayed union and one case needed revision plating. No loss of reduction was seen in any of the cases.

Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study.

OBJECTIVE: Osteoarthritis (OA) is a degenerative, disabling joint disease that affects >10% of the adult population. No effective disease-modifying treatment is available. In the present study, we used joint distraction, a relatively new treatment in which mechanical contact between the articular surfaces is avoided while intraarticular intermittent fluid pressure is maintained, to treat patients with severe OA of the ankle. METHODS: Patients with severe ankle OA (n = 57) who were being considered for joint fusion (arthrodesis) were treated with joint distraction in an open prospective study. In addition, a randomized trial was performed in 17 patients to determine whether joint distraction had a better outcome than debridement. A standardized evaluation protocol (physical examination, assessment of pain, mobility, and functional ability) was used, and changes in radiographic joint space width and subchondral sclerosis were measured. Thirty-eight patients in the open study have been followed up for >1 year, with up to 5 years of followup in 7 of them (mean +/- SD followup 2.8 +/- 0.3 years). Patients in the randomized study have been followed up for 1 year. RESULTS: Significant clinical benefit was found in three-fourths of the 57 patients in the open prospective study. Most interestingly, the improvement increased over time. Radiographic evaluation showed increased joint space width and decreased subchondral sclerosis. Moreover, joint distraction showed significantly better results than debridement. CONCLUSION: The clinical benefit of joint distraction in the treatment of severe OA is proof of the concept. Although the followup remains relatively short and effects over time remain unpredictable, our study creates possibilities for the treatment of severe OA in general. Considering the high prevalence of OA and the lack of a cure for it, joint distraction as a treatment of severe OA may have great medical, social, and economic impact.